Set on a tiered approach to care management, Michigan Pioneer ACO sees the first tier as prevention and wellness, including flu vaccines and annual checkups, according to Michigan Pioneer's President Carrie Harris-Muller. The other tiers are patients with multiple conditions and the terminally ill patients with less than 24 months to live.

"The very ill need a lot of support in the home," Hospice of Michigan CEO Dottie Deremo said in the article. "(People) can have two to 10 crises in the last 24 months of life. The options have been to go to the ER or hospital. We can reduce this with personalized programs."

Identifying the patients for the Personalized Care at Home program may take up to nine months, as hospice looks at 200 to 300 patients at a time to determine if the patients are at end-stage illness.

The time and resources put into the program may be worth it though. Hospice of Michigan research indicates its special program for end-stage illness patients saves 36 percent in medical costs, while providing higher quality care and reducing stress for caregivers during patients' last 24 months of life, Deremo said.

The Michigan Pioneer ACO model points to the important role that hospice plays in the care continuum but also personalized attention required where patients are--at home.

Michigan Pioneer ACO is one of the 32 Pioneer ACOs in the nation, which aims to save Medicare up to $1.1 billion over five years. The program, which started in January, is preceded by the Medicare Shared Savings Program with 27 ACOs that launched this month.

For more information: - read the Crain'sarticle (subscription required) - see the list of Pioneer ACOs - check out the list of Medicare Shared Savings ACOs